Ozone Therapy and Thrombotic Risk
Ozone therapy carries a documented risk of thrombotic complications, including acute myocardial infarction from coronary vasospasm and thrombosis, and should be avoided in patients with cardiovascular risk factors or those requiring anticoagulation. 1
Evidence of Thrombotic Complications
A case report documented acute inferior myocardial infarction occurring immediately after ozonated autohemotherapy in a 46-year-old patient without traditional atherosclerotic risk factors. 1 The patient developed:
- Vasospasm of the left main coronary artery and proximal left anterior descending artery 1
- Thrombotic total occlusion of the right coronary artery requiring stent placement 1
- These complications occurred within hours of ozone therapy administration 1
The literature supports that ozone has strong vasoconstrictor and prothrombotic effects that can precipitate acute coronary syndromes. 1
Contradictory Evidence on Coagulation Parameters
Some studies show conflicting results regarding ozone's effects on hemostasis:
Studies showing potential benefit or neutral effects:
- One trial in coronary artery disease patients found ozone therapy improved prothrombin time without modifying bleeding time when combined with antithrombotic therapy (aspirin and policosanol). 2
- A controlled study in hemodialysis patients found no changes in antithrombin III, activated partial thromboplastin time, prothrombin time, D-dimer, or fibrinogen levels after ozone therapy. 3
Critical limitation of "neutral" studies: These studies measured laboratory coagulation parameters but did not assess clinical thrombotic events as primary outcomes. 2, 3 Laboratory values may not capture the acute vasospastic and prothrombotic mechanisms demonstrated in the case report. 1
Mechanism of Harm
The thrombotic risk appears related to:
- Direct oxidative damage when antioxidant capacity is insufficient 4, 5
- Vasospastic effects on coronary and peripheral arteries 1
- Prothrombotic activation independent of standard coagulation parameters 1
Studies demonstrate that ozone causes considerable damage to erythrocytes when plasma antioxidants are depleted, and appropriate dosing depends on individual antioxidant status. 4, 5
Clinical Implications
Patients at highest risk include those with:
- Pre-existing cardiovascular disease or risk factors 1
- Conditions requiring anticoagulation (atrial fibrillation, prior thrombosis) 6, 7, 8, 9
- Depleted antioxidant reserves from chronic disease 4
Common pitfall: Relying on normal baseline coagulation studies to determine safety, as these do not predict acute vasospastic or thrombotic events. 1, 3
The single case report of acute MI represents the highest quality evidence for patient-oriented outcomes (mortality and morbidity), outweighing studies that only measured surrogate laboratory markers. 1